Implantable cardioverter-defibrillators and the young athlete: can the two coexist?

Since the incorporation of implantable cardioverter-defibrillators (ICDs) into the management of life threatening arrhythmias in the 1980s, tremendous advances in device and lead technology have allowed the implantation of ICD systems in younger and smaller patients. The majority of these young patients with ‘‘electrical’’ cardiac disease and a significant number of those with other indications for ICD placement have near normal to normal cardiac function, which has resulted in a large population of young ICD patients with minimal to no symptoms. This population has pushed the boundaries of published guidelines on activity restrictions for the disease state and the presence of an ICD, creating a dilemma for the patient, the family, and the health care team with regard to which activities should be permitted. Strong evidence suggests that vigorous activity increases the probability of life threatening arrhythmias in the at-risk population. In addition,repetitive training and high levels of exertion may decrease the durability of the ICD system, leading to inappropriate or ineffective device therapy. However, competitive sports promote regular physical activity, even at the novice level, and regular physical exercise confers numerous short- and long-term benefits. The clinician must always balance the potential risk in sports participation for the patient who has an ICD with the documented adverse effects of chronic physical inactivity. The decision to allow sports participation is multifactorial and therefore cannot be made purely on the basis of consensus statements or the patient’s desire to compete.